Pneumococcal Disease

Most serious pneumococcal infections are caused by Streptococcus pneumoniae (pneumococci) serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F. They commonly colonize the respiratory tract and are spread is via airborne droplets. Primary infection usually results in otitis media (most common) and pneumonia (most serious). Other pneumococcal infections include sinusitis, meningitis, endocarditis, and septic arthritis. Adults with a compromised immune system and the elderly are at high risk.45

Active Immunization: Pneumococcal Polysaccharide Vaccine46

There are two pneumococcal vaccines: a conjugated vaccine against 13 serotypes (PCV13 [Prevnar 13]) and a polyvalent polysaccharide vaccine against 23 serotypes (PPSV23 [Pneumovax 23]) (Table 9). Current ACIP guidance recommends a single dose of Pneumovax 23 be administered to all adults ≥65 years of age. The routine use of Prevnar 13 in adults ≥65 years of age without increased susceptibility is no longer recommended. Instead, shared clinical decision-making for the use of Prevnar 13 is recommended for these patients. Prevnar 13 continues to be recommended in series with Pneumovax 23 for adults at increased susceptibility ≥19 years of age. Persons who received a Pneumovax 23 vaccine prior to age 65 and those at increased susceptibility should be revaccinated 5 years after the first dose.

Table 9. Pneumococcal Polysaccharide Vaccine.46
Vaccines Indications Schedules Adverse Effects
Pneumovax 23 Preexposure 1 IM dose Mild to moderate erythema and soreness at the site of injection.